INTRODUCTION TO SENSORY
INTEGRATION THERAPY

Children with Autism Spectrum Disorders such
as Autism or Asperger's
syndrome with frequently have problems with sensory
problems, including their sense of touch, smell, hearing, taste
and sight. Wearing certain fabrics, tasting certain foods, or normal
everyday sounds may cause emotional outbursts. The opposite is also
possible - the child with an Autism Spectrum Disorder may feel
very little pain or actually enjoy sensations we would dislike:
strong smells, intense cold or unpleasant tastes.

Along with this will frequently be difficulties
in movement, coordination and sensing where one's body is in a given
space. The brain seems unable to balance the senses appropriately
in cases of Sensory
Integration Dysfunction. The brain may not be able to filter
out background stimuli yet admit what is important, so the person
with Autism or Asperger's may have to deal with overwhelming amounts
of sensory input day and night.

How sensory integration therapy typically works

The main form of Sensory Integration Therapy is
a type of occupational therapy that places a child in a room specifically
designed to stimulate and challenge all of the senses. During the
session, the therapist works closely with the child to encourage
movement within the room. Sensory integration therapy is driven
by four main principles:

• Just Right Challenge (the child must be able
to meet the challenges through playful activities)
• Adaptive Response (the child adapts behavior to meet the challenges
presented)
• Active Engagement (the child will want to participate because
the activities are fun)
• Child-directed (the child's preferences are used to initiate therapeutic
experiences within the session).

Sensory Integration therapy is careful to not
provide children with more sensory stimulation than they can cope
with. The occupational therapist looks for signs of distress. Children
with lower sensitivity (hyposensitivity) may be exposed to strong
sensations, while children with heightened sensitivity (hypersensitivity)
may be exposed to quieter activities. Treats and rewards may be
used to encourage children to tolerate activities they would normally
avoid.

For more information on Sensory Integration Dysfunction,
see the Sensory
Problems fact sheet.

Guidelines for children with heightened sensitivity

Parents can find it very distressing when if their
child rejects hugs, cuddles and other demonstrations of affection.
This can be interpreted as a personal rejection when it is a discomfort
with unpleasant touch. These guidelines may help in more appropriate
touch with autistic children who have hypersensitivity:

• The child may find it easier to initiate hugging
than receive it

• Touch is often more tolerable when the child
anticipates it

• Firm, unmoving touch is better than light or
moving touch

• Light touch may be tolerable after firm unmoving
touch
• Initial stimulation may be unpleasant but tolerated later.

sensory integration Therapy for different SENSES

Touch

The sense of touch varies widely between children
on the autism spectrum. Many kids enjoy the feel of sticky textures.
Try experimenting with glue, play dough, stickers, rubber toys,
sticky tape. Other things that can be great for tactile sensation
are water, rice, beans and sand.

Children with Autism often enjoy a sense of firm
overall pressure, such as wrapping them up in blankets, being squashed
by pillows and big hugs. These can form a great basis for play,
interaction and showing affection. Experiences that may be claustrophobic
can be liked, such as being squashed between mattresses, and making
tunnels or tents from blankets over furniture. Read Temple
Grandin's
story and the development of her 'hug
machine'.

"Our son hates light touches. But we now
play 'monster attacks', where we pick him up, turn him upside down,
spin him around, throw him on the couch, bury him under cushions
then sit on him, yelling and carrying on the whole time! He loves
it, and over time we worked in hugs and strokes at the end of it
all. Now we can show him affection normally as well, and he is more
comfortable with the rough and tumble play of other young boys".
PDC (we strongly suggest caution if 'burying' a child under
cushions, to avoid suffocation - Ed.)

Appreciation of firm pressure to light touch seems
to be very common on the autism spectrum. Try using deep pressure
with the palm of your hand instead of stroking or light touch. Some
children love being tickled, while of course others will hate it.

Smell

Be aware of your child's response to the smell
of substances too. Experiment with putting different fragrances
in play dough or rice. If your child actively likes strong odors,
find toys that specialize in this.

Sound

Experiment with talking toys, games on computers,
musical instruments, squeaky toys and all sorts of music. Clapping
together, rhymes, repeating phrases and tongue twisters are useful
activities. Auditory
Integration Therapy may help in dealing with sounds.

Some children on the autism spectrum respond
to music but not voices, in which case music
therapy may help. Try speaking in a melodic or “sing-song” voice
and see if the response improves. Try different tones of voice,
pitches, and gauge your child' reaction. Loud or unexpected sounds
generally won't be liked. Explain noisy toys to the child first
then introduce it at a distance. In extreme cases, it may be worth
introducing noise-making toys using social
stories.

Sight

As you can gather, parents may need to play detective
in finding the sensations their child is enjoying. Autistic kids
were often reported as staring at nothing when young by their parents,
when they were actually entranced by the movement of shadows on
a wall, or listening to wind moving through the trees outside. Parents
may need to work hard to find the things their child enjoys visually.
It could be anything that is long and narrow. I might be things
of a precise shade of orange. A preference for looking at straight
lines is often reported. There are many toys that aim at stimulating
sight with bright color schemes and flashing lights. Remember your
child probably won't want to be taken by surprise! In some cases,
visual therapy
may be able to help.

Proprioceptive system

The Proprioceptive System helps children (and
adults) to locate their bodies in space. Autistic children often
have have poor proprioception and will need help to develop their
coordination. Therapy may include playing with weights, bouncing
on a trampoline or a large ball, skipping or pushing heavy objects.

Vestibular system

The Vestibular System is located in our inner
ear. It responds to movement and gravity and is therefore involved
with our sense of balance, coordination and eye movements. Therapy
can include hanging upside down, rocking chairs, swings, spinning,
rolling, somersaulting, cartwheels and dancing. All these activities
involve the head moving in different ways that stimulate the vestibular
system. Be careful to observe the child carefully to be sure the
movement is not over stimulating.

Back and forth movement appears less stimulating
than side-to-side movement. The most stimulating movement tends
to be rotational (spinning) and should be used carefully. Ideally
activities will provide a variety of these movements. A rocking
motion will usually calm a child while vigorous motions like spinning
will stimulate them. Merry-go-rounds, being tossed on to cushions
or jumping trampolines can be real favorites with some children.
Experimenting and careful introduction of each activity is the way
to go!

Learning new skills involving movement

Skills such as tying shoe laces or riding a bike
can be difficult as they involve sequences of movements. Therapy
to help in this area may use swimming, mazes, obstacle courses,
constructional toys and building blocks.

Difficulty with using both sides of the body together

Crawling, hopscotch, skipping, playing musical
instruments, playing catch and bouncing balls with both hands are
some of the many activities that can help with bilateral integration.

Hand and eye coordination

Activities may include hitting with a bat, popping
bubbles, throwing and catching balls, beanbags and balloons.

Is Sensory Integration Therapy a proven treatment?

Although Sensory Integration Therapy is widely
used and supported by anecdotal evidence, there is as yet little
research that would establish it as an evidence-based
treatment. One study found only poor quality evidence providing
either no, or at best equivocal, support for Sensory Integration
therapy (Dawson and Watling 2000). There have been many studies
done but these have not been conducted rigorously enough for Sensory
Integration Therapy to be considered an evidence-based treatment,
despite it being widely used as an intervention for Autism and other
developmental disorders.

I can't afford these therapies, or they don't exist in my area

The good news is that as with many intervention
therapies, they can be done at home by the parents. When finances
are a problem, you may be able to have one or two sessions with
an occupational therapist who is experienced in Sensory Integration
Therapy to get advice on home-based therapies. Contact your local
Autism or Asperger's association as they will be able to put you
in touch with free or low-cost services.

When there are no services in your area, you can
still do home-based
therapies. This fact sheet offers some ideas and there are many
books available on Sensory Integration Therapy. Also, some Autism
associations may respond to email enquiries from parents in remote
regions.